Ear Infections

What is an ear infection?

Ear infections are common. Fortunately, most infections settle without ill effects whether the problem is in the outer, middle or inner ear, although sometimes longer term problems can arise.

The ear is divided into three parts: outer, middle and inner. An infection in each part will give rise to certain patterns of symptoms. These include:

Pain or earache

A discharge which may be blood-stained or smelly

Deafness

Dizziness

Noises in the ear (tinnitus)

The only sign of an ear infection in young children may simply be a fever and some tugging of the ear by the child.

Although earache is a common symptom of ear infection, not all earaches are caused by an ear infection. If a child has earache but is otherwise well, an ear infection is unlikely. A common cause of mild earache is a build-up of mucus in the middle ear after a cold. This usually clears within a few days. Sometimes pain that you can feel in the ear is due to referred pain from other causes such as teeth problems.

Outer ear infections (otitis externa)

This is an infection of the skin of the ear canal and very common. It can be extremely painful so that sleep may be impossible. Generally, outer ear infections are caused by a bacterial infection of the skin of the ear canal, although occasionally it may be due to a fungus or yeast.

The skin can become so swollen that the ear canal closes, causing temporary deafness, and there can be a little bit of discharge from the ear. It occurs commonly in people who suffer from skin problems such as eczema, psoriasis or dermatitis but also in people with narrow ear canals or who swim a great deal.

It can affect both ears and often recurs, especially if you are rundown or stressed. With these types of symptoms a doctor or pharmacist will need to be consulted in order to receive effective treatment.

The treatment for outer ear infections is generally in the form of antibiotic ear drops which are instilled into the ear canal for at least a week. Sometimes antibiotics by mouth will also be necessary. In severe cases referral to an ear nose and throat specialist is both necessary and appropriate for cleaning of the ear canal and more intensive treatment.

Middle ear infections (otitis media)

Middle ear infections are very common, particularly in children. The most common is acute otitis media which is characterised by a severe earache and high temperature, generally in a child, with associated deafness. Like an abscess, once the eardrum bursts and the pus comes out of the ear, the pain eases. Fortunately, the eardrum almost always heals once the infection settles and the hearing also returns to normal.

Longer term problems can occur when such infections are frequent, because there can be damage to the eardrum, or perhaps persistent deafness due to fluid remaining behind the eardrum (termed ‘glue ear’). In such cases referral to a specialist is appropriate.

A second but more serious form of middle ear infection is when it becomes chronic or long-lasting. Generally, chronic middle ear disease is associated with a smelly ear discharge and deafness, but rarely with pain.

Other significant symptoms such as tinnitus (ringing in the ears), weakness of the face or dizziness can occasionally occur. In these cases referral to an ear nose and throat surgeon is very important as the treatment usually involves surgery to remove the infection from the middle ear and mastoid bone. To ignore such disease can be dangerous.

Inner ear infections

Infections of the inner ear are much less common and are generally caused by viruses, although occasionally by secondary bacterial infection. They tend to cause problems with sudden hearing loss or dizziness. The common cold virus is perhaps the most common cause of inner ear infections but many other viruses have also been associated with sudden deafness such as mumps, measles and herpes.

Treatments for ear infections

Infections of the ears that do not settle within a couple of days should be assessed by a doctor and if necessary, referral for specialist help may be considered. Ear infections may be treated with either antibiotic ear drops or antibiotics taken by mouth but in most cases these are not advised initially as most infections usually clear within 2 to 3 days by themselves. Antibiotics are more likely to be prescribed if:

The child is under 2 years old (as the risk of complications is greater in babies)

The infection is severe

The infection does not begin settling within 2 to3 days

Complications develop. When the infection is severe, admission to hospital may be necessary for antibiotics via a drip. In some complicated cases surgery may be the best form of treatment